In Nursing Education AACN Shaping A Future Vision For Nursing Education and Clinical Nurse Leader is a struggle for upcoming days of nursing profession. AACN has adopted a new position which recognizes the Doctor of Nursing Practice degree as the highest level of preparation for clinical practice.
The Clinical Nurse Leader: AACN Shaping A Future Vision For Nursing Education
In this possible new vision for nursing education explained here, master’s education programs would prepare advanced generalists in nursing, either as entry into the profession or in post baccalaureate nursing education programs. The Clinical Nurse Leader (CNL), launched as a demonstration project, is being developed in collaboration with multiple stakeholders from practice and education.
Currently, 90 schools, in partnership with more than 185 health-care facilities, are piloting a master’s CNL curriculum and working to develop a new health-care delivery model. Other possible master’s degree tracks may include preparation for middle management and informatics roles. The CNL is an advanced generalist prepared at the master’s degree level. Some of the key characteristics of the CNL role include (AACN, 2003):
- Implementation of evidence-based practice in all health-care settings for diverse and complex patients
- Risk anticipation, evaluating, and anticipating risks to client safety with the aim of quality improvement and preventing medical errors
- Lateral integration of care for a specified cohort of patients
- Accountability for evaluation and improvement of point of care outcomes
- Mass customization of care
- Client and community advocacy
- Client education for individuals, families, groups, and other health-care providers
As the national voice for baccalaureate and higher degree nursing programs, AACN has established the educational standards and curricular guidelines through a series of Essentials documents that delineate the essential components and outcomes of baccalaureate and graduate nursing programs.
- Information management—using information systems and technology at the point of care to improve health-care outcomes
- Delegation and oversight of care delivery and outcomes
- Design and provision of health promotion and risk reduction services for diverse populations
- Team leadership and collaboration with other health professional team members
- Development and leveraging of human, environmental, and material resources
As a generalist, the CNL is not an Advanced Practice Registered Nursing (APRN). APRNs are prepared in an advanced specialty area of practice. The CNL collaborates with and complements APRN roles, including the Clinical Nurse Specialist (CNS) and the Nurse Practitioner (NP), to improve patient care outcomes. The graduate level education of the CNL builds on professional nursing baccalaureate degree competencies and practice (AACN, 1998).
The graduate of a CNL master’s program is prepared as a generalist to provide care at the point of care and specific clinical leadership throughout the health-care delivery system. The nursing profession must produce quality graduates who:
- Are prepared for clinical leadership in all health-care settings.
- Are prepared to implement outcomes-based practice and quality improvement strategies.
- Will remain in and contribute to the profession, practicing at their full scope of education and ability.
- Will create and manage microsystems of care that will be responsive to the health-care needs of individuals and families (Batalden, Nelson, Edwards, Godfrey, & Mohr, 2003; Mohr et al., 2003). Unless nursing is able to create a professional role that will attract the highest quality men and women into the profession, nursing will not be able to fulfill its covenant with the public.
Specialty Nursing Practice and the Doctor of Nursing Practice
The Position Statement on the Practice Doctorate in Nursing, approved in Fall 2004 by the AACN membership, recommends moving all specialty nursing education to the doctoral level by the year 2015. With this recommendation, all current APRN education, which includes certified registered nurse anesthetist, certified nurse midwife, clinical nurse specialist, and nurse practitioner roles, would evolve to the doctoral level by 2015.
The recommendation does NOT intend that all currently practicing APRNs will be required to obtain this new degree. It is intended that currently practicing and credentialed APRNs will maintain authority to practice just as occurred when, in the 1970s, NP education evolved from certificate to master’s education. The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) addresses those areas of competency necessary for all doctor of nursing practice graduates and includes:
- Scientific underpinnings for practice
- Organizational and systems leadership for quality improvement in systems thinking
- Clinical scholarship and analytical methods for evidence-based practice
- Information systems and technology for the improvement and transformation of patient-centered health care
- Health-care policy for advocacy in health care
- Inter-professional collaboration for improving patient and population health outcomes
- Clinical prevention and population health for improving the nation’s health
- Advanced nursing practice for specialty roles
The Essentials document has a format similar to that of the AACN Essentials of Master’s Education for Advanced Practice Nursing (AACN, 1996) and includes the core competencies for all DNP graduates. The specialty role competencies, an essential component of the DNP curriculum, will be identified by the specialty nursing organizations. A diagram of the DNP curriculum, as currently envisioned.
An individual may enter a DNP program following a baccalaureate nursing education program, a master’s advanced generalist program such as a CNL program, or one of the current master’s APRN programs. Therefore, the DNP Essentials or end-of-program competencies include all of the post-baccalaureate nursing competencies necessary upon graduation from a practice doctor ate in nursing program.
Following the transition to this new model of specialty nursing education, it is possible that the current Essentials of Master’s Education may be retired, having been replaced by the new Essentials of the Doctor of Nursing Practice and possibly a new set of guide lines for advanced generalist education at the master’s level.
A New Model for Nursing Education
With the proposed future changes in nursing education, a number of different models are possible. One such model for future nursing education and the entry points and pathways that could be taken throughout the model are presented here.
Educational Pathways
For the health of the profession, nursing must maintain a robust pipeline of entry-level physicians and provide seamless pathways to higher levels of educational achievement. Mechanisms must be strengthened to allow articulation or transition from one nursing degree program to another.
These pathways should ensure that individuals receive appropriate academic credit for previous education and clinical experiences, that appropriate course and credit requirements are assigned to appropriate degrees, and that program requirements are not redundant. Ensuring these transition mechanisms also should standardize nursing education program expectations, including length of programs and ranges of credit and clinical requirements, and should improve access to the continuum of nursing education programs.
Completion of each degree should be based on documentation of end-of-program competencies delineated in the Essentials for each degree (baccalaureate, master’s, and doctoral). This requires nursing, just as the rest of higher education is doing, to examine and develop new mechanisms for assessing outcome competencies, such as virtual testing, simulations, and portfolio development (AACU, 2004).
Individuals will enter the profession through a number of entry points. One point of entry is the BSN program offered through an articulation agreement between a community college and upper degree granting institution or solely by the upper degree granting institution. Graduates of a BSN program are prepared to sit for the nursing licensure exam (NCLEX).
A second point of entry into the profession is at the master’s degree level. Individuals entering a master’s in nursing program must have completed a baccalaureate degree in another field or a pre-nursing baccalaureate degree. This model parallels other health professions’ education, including medical education. A pre-nursing degree would include a broad base of physical and social sciences and other general education courses.
When entering the nursing profession at the master’s degree level, the nursing program must ensure attainment of the baccalaureate nursing practice competencies. In this educational model, as envisioned, master’s education programs would prepare advanced generalists in nursing. This may include education tracks preparing Clinical Nurse Leaders.
Other possible tracks may include preparation for middle management roles. Research-focused education programs that award a PhD, DNS, or DNSc degree, prepare graduates for research careers. Graduates of these programs may assume positions in academia, practice, policy, or administration. The primary focus of the PhD or other research- focused programs is to prepare individuals to advance the science of nursing through the generation of new nursing theory and knowledge.
Doctor of Nursing Practice programs prepare graduates for a variety of roles with an emphasis on nursing practice. DNP is the degree title awarded and does not indicate the graduate’s specialty area of practice, which includes any of the APRN roles, or may include health policy, informatics, organizational leadership, or community health nursing. Entry into a DNP program may be post-BSN or post-MSN.
During the transition to this new model of nursing education, many DNP students who choose to advance their education will have already completed an MSN program in one of the APRN roles. Curricula will need to be individualized to the student’s previous educational background and clinical experience.
Preparation for Faculty Roles in Academia
Consistent with expectations in other disciplines, the appropriate preparation for nursing faculty is at the doctoral level. Expectations for nursing faculty should not differ from those of other disciplines within the academic community. Graduates of both research-focused and practice doctorate programs are eligible for full participation in a faculty role consistent with the institution’s criteria. Education is a discipline itself.
Additional coursework or opportunities for obtaining pedagogical expertise may be provided as part of the doctoral program or through a mentoring program for new faculty. Nursing education is not an appropriate area of focus for either the PhD or DNP degree. Rather, the primary area of preparation in a doctoral nursing program should be in an advanced area of nursing practice or nursing research.
Summary
Nurses, more than any other health professionals, have constant contact with patients and opportunities to influence outcomes of care. Nurses provide services across the continuum of settings from critical care, senior day care to school health facilities. The IOM and other well-respected interdisciplinary groups have urged all health professionals to redesign the way future practitioners are prepared.
Current and projected changes in an increasingly complex health-care system and the nursing profession ‘s potential to influence health-care outcomes have created a powerful man date to prepare a highly and differently educated future nursing workforce. Nursing also must participate in and lead the redesign of care delivery models. New practice and education models are needed to attract highly qualified and professionally motivated individuals to the profession.
This vision presented is just one possible model for future nursing education. This model includes a minimum of a baccalaureate degree for entry into professional nursing practice, graduate level preparation in an advanced generalist role, doctoral preparation for practice in all nursing specialties, and research-focused doctoral preparation to expand nursing knowledge and scientific base. What may occur in the future cannot be predicted and will be dependent upon the nursing community as a whole.
A future nursing education model requires an evolution and expansion of nursing education at all levels of practice. The nursing profession cannot afford to be the least educated profession at the health professions’ table. Nursing cannot rely on past experiences and current practices. An open, thoughtful, and creative dialogue is needed to achieve this new model of nursing education, for which the ultimate goals are an expanded highly educated nursing workforce, increased access to high-quality care, and improved health-care outcomes.
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